Provider Demographics
NPI:1023200730
Name:MICHAEL R. GILDEA PC
Entity Type:Organization
Organization Name:MICHAEL R. GILDEA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GILDEA
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, LPC, CAC
Authorized Official - Phone:570-522-8330
Mailing Address - Street 1:88 N BULL RUN XING
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6725
Mailing Address - Country:US
Mailing Address - Phone:570-522-8330
Mailing Address - Fax:
Practice Address - Street 1:88 N BULL RUN XING
Practice Address - Street 2:SUITE 6
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6725
Practice Address - Country:US
Practice Address - Phone:570-522-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA607049251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health